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NPI Code Detail

MEDICARE: GARY D VANDE KAMP PT

MEDICARE: GARY D VANDE KAMP PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist00183IA
2225100000XPhysical Therapist070001377IL

General Provider Information

NPI Number : 1871589820
Entity Type Code : Individual
Provider Name (Legal Business Name) : GARY D VANDE KAMP PT
Provider Business Mailing Address
First Line : 850 43RD AVE
Second Line : SUITE 100
City : MOLINE
State : IL
Zip : 61265-8401
Country : US
Telephone Number : 309-743-2070
Fax Number : 309-743-2073
Provider Business Practice Location Address
First Line : 635 E LINCOLNWAY
Second Line :
City : MORRISON
State : IL
Zip : 61270-2963
Country : US
Telephone Number : 815-772-7274
Fax Number : 815-772-4590
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/26/2005
Last Update Date : 04/12/2012

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